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Should Your Agency Bring EMS Billing In-house?

ZOLL Data Systems | Jan 16, 2023

Is it worth it to bring your EMS billing in-house? Sooner or later, every organization that outsources its billing and collections functions will consider bringing them in-house. This is a big decision that’s not to be taken lightly. This article will help you assess whether a change is right for your organization and define the practical steps for a successful transition, should you decide to move forward.

Questions To Ask Before Bringing Billing In-house

When deciding whether to bring billing in-house, start by carefully assessing the pros and cons to help you assess your readiness to take on this function:

Performance of Your Current Billing Service. Determine if you are receiving industry-standard metrics on a monthly basis.

  • Are reimbursements and invoices paid correctly and on time?
  • Does your account revenue correlate to your volumes?
  • Are self-pay collection efforts optimized through automated insurance discovery or retroactive Medicaid finder technology?

Cost of Your Current Billing Service vs. In-house Billing. Do the math to compare what you’re currently spending for a billing service with buying software and hiring and/or training staff.

  • What is the cost of your current billing service?
  • How many claims do you process per day? Per month?
  • How much are you currently spending per claim?
  • How much would it cost to purchase EMS billing software?
  • How many staff members would you need to hire to manage billing? (Hint: Determine the average number of claims a typical person can process in a day and divide that by your total number of claims.)
  • What would it cost (salaries) to hire the needed staff members?

Current Billing Service Contract. Review your contract to make sure you don’t get into hot water if you end or change the relationship with your billing company.

  • Are you contractually obligated to use the billing company’s services for an established period of time?
  • Is there exclusivity language in the contract limiting you from bringing all or part of billing functions in-house?
  • What is the specific language relating to breach of contract?

Finding the Right Billing Software
If the pros outweigh the cons and it makes both operational and financial sense to bring billing in-house, the next step is to find a robust EMS billing solution that’s a good fit for your organization. The billing software should be intricate enough to manage dynamic situations within EMS billing. Best-in-class solutions like ZOLL® Billing help control costs, increase productivity, and accelerate reimbursements — all essential for keeping EMS agencies rolling.

Aside from the feature set, the software should deliver maximum value. For example, claims functionality, coverage eligibility, discovery demographics, and other capabilities should be baked into the software’s pricing. You don’t want to incur separate transaction fees at 3.5% to 5% per transaction — those can quickly erase anticipated savings.

How To Transition to In-house Billing
Once your organization decides to handle billing in-house and chooses an EMS billing solution, remember that you can ease into the transition. It doesn’t have to be an all-or-nothing situation that you dive into head first.

Ready To Jump in? Ramp Up Your Knowledge Now
Here are three things you can do now to ramp up your EMS billing industry knowledge and be prepared for the in-house transition:

  • Subscribe to emails from the  Centers for Medicare & Medicaid Services (CMS). They are a great resource for up-to-date information on state compliance and are typically seen as an industry benchmark for other insurance.
  • Sign yourself or your staff up for billing and coding certifications from the National Academy of Ambulance Compliance (NAAC) and the American Academy of Professional Coders (AAPC).
  • Download the complimentary eBook, "Bring Your EMS Billing In-house With These 8 Steps,” for more information and clear instructions on how to make the transition.


Remember: bringing your billing in-house is an ongoing process with a high learning curve. Be patient with yourself and your team as you learn the ins and outs of EMS billing.

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